AmAzInG

Pengikut

Arsip Blog

Si-PeNuLiS

i have finished my study in Midwifery Program Study oF meDical FacUlty oF SeBelas MaRet university...i want to sHare all oF my exPeriences eN mY sciEnce thAt i've Got unTil today. i hope All of them wiLl heLLp evEry one that needed...

Part 2: What is a healthy baby?15Recipe, continued on next pageMother’s Milk—A Recipe for SuccessMorena Parada, a mother of three girls, understands that breastfeedingcan be a complicated issue for new moms. On one hand, researcherspoint to a wide range of benefits that breastfeeding affords a baby—from a stronger immune system to a higher I.Q. But for some women,nursing can be difficult or even painful at first. Some women may alsoworry about how people will react if they nurse their baby—especiallyif they are the first person in their family or the only one amongfriends who decides to breastfeed.“For me, it came down to doing the best thing for my baby,” saysParada, a 31-year-old mother from Alexandria, Virginia. “I think nursinghas helped my girls be healthier. They rarely get sick, and I think thatnursing is one of the reasons.”Parada first made the decision to breastfeed eleven years ago when hereldest daughter, Vicky, was born. Initially, the decision was made basedon convenience: Parada liked not having to worry about warming milkin the middle of the night, toting bottles whenever she went out, orpaying for expensive formula. But there was an intangible benefit thatoutweighed all others: the time spent nursing made her feel especiallyclose to her baby.“It was our special time,” Parada said. “I would sing to her in Spanish,and hold her as close to me as I could.”When her second baby, Karina, now 41/2 years old, was born Paradaknew she would again breastfeed. And she did for 21/2 years.Currently nursing her third child, Diana, age 1, Parada is a veteran ofbreastfeeding and a vocal advocate. As part of her commitment tokeep her children healthy, Parada visits the clinic sponsored by theAlexandria Neighborhood Health Services, Inc., a neighborhood-basedcenter that is geared toward the Hispanic population and dedicated tomaking sure that women and children in need receive basic health care.While at the clinic, Parada encourages expectant mothers to give nursHa v i n g H e a l t h y B a b i e s : T h e S c i e n c e I n s i d e16ing a try, and for new mothers who are having a difficult time, she urges perseverance.Breastfeeding came easy to Parada, but she knows that is not the case foreveryone. “It is not always easy for new mothers. They complain about sorenessand sometimes the baby doesn’t take to it right away. It can be frustrating.I just tell the moms to give it a chance, but I understand that for somemothers it’s really hard, especially when they don’t get support from others.”Support is something Parada feels blessed to have. Her husband, Nicholas,understands and appreciates what she is doing for their baby, and she findscomfort in knowing that so many of her friends and relatives have made thesame choice.In fact, research shows that Parada has a lot of company. A recent nationalsurvey found that breastfeeding in the United States is at a record high, with69.5 percent of new mothers starting out breastfeeding. Equally impressive isthat 32.5 percent are still nursing six months later.For a variety of reasons, breastfeeding is not for every mother, but clearlymore and more women like Parada are viewing breast milk as a recipe fortheir children’s success.17Part 3: Health careduring pregnancyand childbirthRecognizing pregnancyAs soon as conception begins, themother’s body begins to change. Thefirst unmistakable sign of pregnancyis missing a menstrual period. Asexually active woman who misses aperiod should suspect pregnancyfirst, even though there may beother causes. Other early warningsigns include sore breasts, more frequenturination, nausea and vomiting(morning sickness), andfatigue. A woman who suspects sheis pregnant might want to use ahome pregnancy test to confirmher suspicions.By the time the mother recognizesthe pregnancy, the embryo has probablybeen alive for two to four weeksor more. A woman who thinks she ispregnant should immediatelybehave as if pregnant—stop smoking,stop drinking alcohol and takingdrugs, start eating right, and soforth. She should seek prenatal careas soon as possible.Prenatal careThe first trimester. The first prenatalcare consultation should takeplace soon after the first signs ofpregnancy, preferably by theend of the second month. Amother will profit most fromthe visit if she comes preparedwith the medical historiesof both herself andthe child’s father.At the first visit, healthcare professionals will ask questionsabout the mother and father’s generalhealth and lifestyles. If necessary,they will recommend changes.The mother might be asked tostop smoking, drinking alcohol,and abusing drugs. The doctorwill ask what prescription andover-the-counter drugs she is taking.Often the doctor will recommendthat she stop taking thedrugs and suggest alternativetreatments during pregnancy.The doctor will also review themother’s medical history for diseasesor conditions that might berisk factors in the pregnancy. Whenthe mother has a medical conditionsuch as obesity, diabetes, or highblood pressure, the doctor willadvise her on how to control diseaseduring this critical time. The doctorwill test the mother for rubella(German measles), HIV, and hepa-A motherreceiveshealthcounseling.Babies need prenatalcare during pregnancyand postnatal care afterthey are born.H a v i n g H e a l t h y B a b i e s : T h e S c i e n c e I n s i d e18titis B—diseases that are especiallyharmful to the embryo. A hemoglobintest establishes how healthy themother’s blood is.Whenever possible, the father’s medicalhistory is reviewed as well.Looking at the genetic history helpsparents and their doctors decidewhether to perform genetic testing.Some genetic conditions have a muchhigher incidence among certain ethnicgroups. For example, people ofEuropean descent have a higher rateof cystic fibrosis. Tay-Sachs,Canavan, and Gaucher’s diseasesare more common among Jewish people.Sickle cell disease has a higherincidence among African Americans.Thalassemia occurs more oftenamong Asian Americans and thoseof Mediterranean descent.Prenatal health care professionalswill also advise mothers about diet,nutrition, exercise, health environments,and other aspects of pregnancy.They will set up a prenatal careschedule for the rest of the pregnancy,usually with monthly visits.During the first trimester of pregnancy,many women suffer discomfortssuch as nausea, backaches, andfatigue. Health care professionalscan help women alleviate these discomforts.Good nutrition, exercise,and other good health habits can alsohelp the mother feel better.The second trimester. This is usuallythe most comfortable trimesterfor both healthy babies and healthymothers. The discomforts of earlypregnancy usually go away. The babybegins to grow, and the mother beginsgaining weight. A healthy amount togain during the second trimester is 3to 4 pounds per month. Regular prenatalcare should continue, with visitsto the doctor at least once a month.By this time, the baby will havegrown enough for the mother and doctorto hear the baby’s heartbeat. Themother also feels the baby movinginside her womb.HIV/AIDS and Pregnancy• HIV (human immunodeficiency virus) causesAIDS (acquired immune deficiency syndrome). AIDSis passed on through sexual intercourse or exposureto infected blood.• Being infected with HIV (being “HIV positive”)and having AIDS are risk factors for pregnancy.They are associated with premature births andother complications in pregnancy and with lowbirth-weight babies.• Mothers can pass on HIV and AIDS to theirunborn infants. Without treatment, babies areinfected in 1 out of every 4 cases.• The risk of infection to infants can be greatlyreduced by treating the mother with the drug AZT(zidovudine) during pregnancy.• To avoid blood exchange and contamination ofthe baby during delivery, the doctor might recommenddelivery by caesarean section (c-section).• Babies of mothers who have HIV or AIDS shouldbe tested soon after birth. New tests can identifymost infected babies by one month.• Babies of mothers who have HIV or AIDS are atcontinued risk from the virus during their first yearof life.Warning SignsduringPregnancyThe AmericanMedical Associationrecommends that apregnant woman seeher doctor if sheexperiences anyof the followingsymptoms:• Abdominal cramps,contractions, orother pain• Persistent, dullbackache• Pressure in thepelvis• Leaks of blood orother fluid fromthe vagina• Pain or burningupon urination• Headaches andblurred vision• A fever with atemperatureover 100°F• A lower fever thatlasts for more thana few days• Extreme or suddenswelling of thehands or feet19In normal, healthy pregnancies,health care providers can easilymonitor the baby’s progress withouthigh technology. They measure themother’s expanding body and checkthe position of the fetus and theshape of the uterus. Vaginal examinationalso shows how a pregnancyis progressing. Doctors and nursesask questions about abnormal spottingor other symptoms the mothermight be experiencing. Additionalblood and urine testing might alsobe used to monitor health.Under special circumstances, thedoctor might also order moreadvanced tests of the baby’s health.Ultrasound tests, amniocentesis,chorionic villus sampling (CVS),and alpha-fetoprotein screeninghelp health care professionals monitorthe health of both the motherand the baby. These tests are notroutine. They are done if the motherasks for them, or if the doctorthinks they are medically necessary.At least two of the procedures—amniocentesis and CVS—have somepossible harmful side effects.Women and their doctors or midwivesmust weigh these risks whendeciding on this testing.The third trimester. The lasttrimester can get increasinglyuncomfortable for both the baby andthe mother. The baby moves aroundless, but restricts the movements ofthe mother more. It might becomenecessary to have more frequentprenatal care visits. The mothershould be careful to eat properlyand to gain the right amount ofweight. The total weight gain duringpregnancy should be 25 to 35pounds (for mothers of normalweight).During the third trimester themother might experience more discomfort—such as frequent urinationand constipation—as a directresult of the growing baby.Backaches, swollen veins, and otherproblems might also develop. Themother should watch herself closely,keep track of her symptoms, anddiscuss them with her obstetrician.This is especially true for high-riskpregnancies.This is the time when the womanand her doctor or midwife will bemaking decisions about how andwhen the baby will be delivered.The medical condition of the motheror baby might lead the doctor toadvise a caesarean sectionPart 3: Health care during pregnancy and childbirthUltrasound scanning is often performedduring pregnancy as a routine check-up.The size of the fetus is assessed and anyabnormalities in growth or developmentcan be discovered.(c-section). In a c-section, the babyis delivered through a surgical incisionof the uterus. For routine vaginalbirth, the mother might electto give birth without medications.The mother might want to attend achildbirth class to prepare for laborand delivery. The father is alsoencouraged to attend these classes.Parenting classes help parents preparefor feeding, changing, and cleaningthe newborn infant. Healthexperts recommend that parents getas much training as possible whilethey await the baby’s birth.Nutrition, exercise,and environmentGood prenatal care is up to the motheras well as her doctors. The mother20H a v i n g H e a l t h y B a b i e s : T h e S c i e n c e I n s i d eThese conditions are usually not dangerousand can be treated by changing your diet,behavior patterns, or medications. However,your doctor should monitor any of these conditions,since they can lead to more seriouscomplications.Morning sickness. Nausea and vomiting,which usually occur during the first trimester.Affects about half of all pregnant women.Recommended treatments include eatingcrackers or other bland food before gettingout of bed, eating several small meals a day,avoiding foods that trigger nausea, drinkingplenty of fluids, and drinking tea or eatingfoods that contain ginger.Anemia. An inadequate level of hemoglobinin the blood that is caused by too little iron orfolic acid in the diet. Symptoms includefatigue, fainting, pale skin, heart palpitations,and breathlessness. Treatment includes addingiron-rich foods (leafy green vegetables, lentils,cooked dry beans, and citrus fruits) to yourdiet. This condition must be monitored carefullyto avoid more serious problems.Edema. Swelling caused by extra fluid in themother’s body that is often brought on bywarm weather. Treatment includes puttingcold-water compresses on the affected areas,avoiding salt, and elevating the legs and feet.Sudden swelling of the face, legs, or feetrequires immediate medical attention.Varicose veins. Painful and swollen veins,especially in the legs, due to an increased volumeof blood in the body. Afflicts about 20percent of pregnant women. Treatmentincludes staying off your feet and wearing supportstockings and loose clothing.Constipation. Slowed bowel activity, oftencaused by pressure from the growing baby.Treatment includes drinking 2–3 quarts of fluidsper day; getting moderate daily exercise;eating fruits, whole grains, and vegetables;and taking fiber formers or laxatives under adoctor’s supervision.Hemorrhoids. Enlarged veins in the anus,often due to the increased pressure of constipation.Treatment includes avoiding constipation,avoiding strain during bowel movements,taking warm baths, and applying witch hazelcream.Heartburn. Burning sensation in the stomach,often caused by the expanding uterus pushingon the stomach. Treatment includes eatingsmaller meals more often, eating more slowly,avoiding greasy foods and coffee, raising thehead slightly during sleep, and taking simpleantacids under a doctor’s supervision.Backache. Low-level pain in the lower back orligaments, caused by the weight of the growingbaby. Treatment includes controllingweight, eliminating strain, and getting moderateexercise.Disturbed sleep. Can be caused by all of theabove discomforts, as well as by stress, anxiety,or depression. Treatment includes avoiding caffeine,avoiding large meals before bedtime,and getting more exercise.Common Medical Conditions during Pregnancy21will also need the cooperation ofeveryone in her household.Nutrition. A pregnant womanshould stop smoking or inhalingsecond-hand smoke. She shouldstop drinking alcohol. She shouldstop using illegal drugs. She shouldcut down on or eliminate sugar,junk foods, fatty and salty foods,and caffeine. Instead, she shouldfollow a well-balanced diet that isrich in whole grains, fruits, andvegetables.Variety in nutrition is important inorder to make sure the mother andbaby get all the nutrients theyneed. Pregnant women need proteinfor cell growth and blood production;carbohydrates for daily energy;calcium for strong bones and teethas well as for muscle contractionand nerve functions; iron for redblood cell production; and fat forstored body energy.The role of vitamins in promotinghealth is also well known. Pregnantwomen need vitamin A for healthyskin, good eyesight, and strongbones; vitamin C for healthy gums,teeth, and bones and for healthyabsorption of iron; vitamin B6 forhealthy blood cell formation and tohelp the body use proteins, fats, andcarbohydrates; vitamin B12 for redblood cell formation and maintainingnervous system health; vitaminD for healthy bones and to aid inabsorbing calcium; and folic acid forblood and protein production. Mostpregnant women should take vitaminsupplements to make sure alltheir needs are met.Exercise. Research shows thatexercise is not just safe for pregnantwomen but beneficial. A womanshould consult her doctor, however,before beginning her exercise program.If she already exercisesregularly, she should clear herroutine with her doctor during herfirst prenatal care visit. Jogging,running, horseback riding, andother exercises that require jerky,bouncy movements are not recommendedfor pregnant women.Exercises to strengthen the pelvicmuscles are especially recommendedfor pregnant women. Kegelexercises strengthen the musclesthat support the uterus, bladder,Part 3: Health care during pregnancy and childbirthH a v i n g H e a l t h y B a b i e s : T h e S c i e n c e I n s i d e22urethra, and rectum. During the lasttrimester of pregnancy, mothersshould undertake exercise plans toprepare for labor. Mothers can learnsuch exercises at Lamaze or otherchildbirth classes.Safe environments. Clean householdand work environments protectthe mother and baby from bacterialinfections during pregnancy andearly infancy. These are the mostcritical times for the baby’s health.The mother and other householdmembers should take extra care touse high standards of hygiene.Changing cat litter is unsafe for apregnant woman because cat fecescarry the bacteria toxoplasmosis.Pregnant women and their babiesare more vulnerable to listeriosisand other forms of food contamination.According to the Center forDisease Control, pregnant womenare 20 times more likely than otherhealthy adults to get listeriosis.Changes caused by hormones arethought to make pregnant womenmore susceptible. Greater care thanusual should go into keeping kitchensurfaces clean, washing food, andcooking food thoroughly.Health care experts are also becomingmore concerned about unsafework environments during pregnancy.Pregnant women who workshould examine the hygiene standardsin their workplace restroomsand kitchen areas. Women shouldalso check for potential health hazards,such as harmful chemicals,that are used in the process of theirwork. Women should discuss theirenvironmental safety concerns withhealth care professionals.Labor and deliveryIn most pregnancies, labor beginswith a series of noticeable changes.Pain Relief during DeliveryEach of these methods has advantages and drawbacks. The mother and her doctor ormidwife should discuss available options and make decisions as pregnancy advances.Epidural. Insertion of a needle into the epidural space at the end of the spine.This numbs the lower body.Intravenous analgesic. Pain-relieving drug administered through a tube insertedinto a vein.Lamaze (natural childbirth). Series of techniques for breathing and for stretching andrelaxing the muscles to aid in labor and delivery without medications.Local analgesic. Pain-relieving drug administered locally through a needle insertedinto a muscle.Pudendal block. A procedure that numbs the area around the vulva.The mother feels the baby descendinginto the pelvis. The mothermight begin to feel small, irregularcontractions of her uterus. Crampsin the lower back are another signlabor is approaching.When these signs appear, the motherand her health care providersshould make final plans for thedelivery. One important decisionto be made is what kind of painrelief, if any, will be used duringthe delivery.The unmistakable signs of labor areregular labor pains and breakingwater. A woman’s water sometimesbreaks first, but it usually happensafter labor pains have begun. Thepains come more frequently andstrongly as labor progresses. Awoman who has begun labor shouldimmediately set the delivery plan inmotion—call the doctor or midwife,or get to the hospital or birth center.The mother will be examinedand then admitted or sent home toremain on close watch, with emergencyplans in place.Most births are healthy. The mother’suterus contracts, which widensthe cervix. When the cervix is wideenough, the mother begins to push.The baby is thrust downward witheach contraction, and then finallyslides down into the birth canal andemerges head-first. The doctor andmedical attendants guide the babygently into the world. Attendantsquickly remove the mucus from thebaby’s mouth and nose, and thebaby makes its first cry. Often thebaby is placed immediately on itsmother’s stomach. The umbilicalcord is cut.Several quick screening tests areperformed on the baby immediatelyafter birth, usually right in thedelivery room. Attendants weighand measure the baby. They performa simple visual test and give23Part 3: Health care during pregnancy and childbirthThe mother’s womband birth canalprepare for deliveryand the fetus movesinto position forbirth when thepregnancy hasreached “term”in approximately9 months.Daily FoodPortions duringPregnancyAccording to theMarch of Dimes, apregnant woman’sdaily diet shouldinclude the following:• 6 to 11 servings ofbreads and otherwhole grains• 3 to 5 servingsof vegetables• 2 to 4 servingsof fruits• 4 to 6 servings ofmilk and milkproducts• 3 to 4 servings ofmeat and proteinfoods• 6 to 8 glasses ofwater, and no morethan one soft drinkor cup of coffee perday to limit caffeine24H a v i n g H e a l t h y B a b i e s : T h e S c i e n c e I n s i d ethe infant an Apgar score, whichmeasures the baby’s overall responsiveness.They wrap the baby in ablanket for warmth. They give thebaby an injection of vitamin K, whichprevents bleeding. They also use eyedrops that contain an antibiotic, toclean out possible infections from thebirth canal.Most births that are not routinealso result in healthyinfants. For example, abreech birth, in which thebaby emerges feet first,makes for a more complicateddelivery. But when moderndelivery procedures arefollowed, there is usually noharm to the baby. Birth bycaesarean section (c-section)is a safe alternative in complicateddeliveries.For the baby, the medical procedureimmediately after birth by c-sectionis usually the same as in a routinevaginal delivery. However, themedical staff will be alert for possiblecomplications and prepared to offeremergency care to both mother andinfant. For example, a birth byc-section might require the temporaryuse of an incubator. Delivery bysurgery will also mean a differentrecovery process for the mother.Postnatal careMost new mothers and their infantsgo home after only a few days in thehospital. Recovery from even ahealthy, normal pregnancy and deliverytakes several weeks. Both motherand baby need adequate diets, plentyof rest, and freedom from stress.Feeding the newborn infant.Whenever possible, mothers shouldbreastfeed their infants right afterbirth. To encourage breastfeeding,many health care centers offerbreastfeeding classes, beginning verylate in pregnancy. Mothers who cannotbreastfeed can be reassured thatbottle feeding is also a healthy alternative.If a c-section has been performedor there have been complicationsduring delivery, breastfeedingmight have to be delayed a few hoursor days. In some cases, bottle feedingis actually healthier for the baby.For example, the mother might be tootired to nurse, or she may be using adrug that enters her breast milk.The decision of whether to breastfeedor bottle feed depends on themother’s individual circumstances.Recovery for the newborn infant.A newborn infant spends most of thefirst few days after birth sleeping andrecuperating. The newborn is quitefragile, especially in the neck andspine. It is usual for babies to loseweight during the first few days afterbirth, because they are losing extrabody fluids. At about five days old,the healthy infant starts to regainweight, reaching the original birthweight about ten days after birth.After that, the baby gains weightquite rapidly.Most deliveriesare routine andsafe for bothmother andbaby.25Part 3: Health care during pregnancy and childbirthSnuffing out SIDSIt seems like children have beentagging around after Amanda SueBordeaux all her life – and Bordeauxcouldn’t be happier about it. As thethird-oldest in a family of nine kids,Bordeaux learned at a young age howto comfort and care for babies. Whenshe was in high school, she ran a tutoringand nutrition program for youngerchildren after school. Now that she’s agrandmother, Bordeaux isn’t slowingdown; she runs an in-home daycareprogram with 12 to 15 children.“I think my daycare career really startedwhen I was 10 years old,” laughed Bordeaux as she chased her two-yearoldgrandson around her home in Rosebud, South Dakota.But a moment later, she turned serious. Bordeaux, who is Native American,has become increasingly worried about the number of babies on her reservationwho have died in their sleep from Sudden Infant Death Syndrome,or SIDS.“Recently there have been a lot of baby deaths, and I’m kind of baffledabout it,” Bordeaux said. “Because I take care of a lot of kids I hear aboutit from different people. Fortunately I’ve never had anything happen to achild in my care, but one of my fellow daycare providers had taken care ofa child who passed away from SIDS recently.”That’s why Bordeaux, who is a member of the Comanche tribe, attended arecent two-day conference on SIDS held in Rosebud, which drew expertsfrom as far away as Washington, D.C. The conference was both scary andreassuring, said Bordeaux. It frightened her to realize that South Dakota isin the region of the country that has the highest rate of SIDS. But she feltbetter knowing that parents and caregivers can do many things todecrease the chance that SIDS will strike their babies.The conference was really a brainstorming session, said Bordeaux. “Themain objective was how we can get the word out to the Native AmericanSIDS, continued on next pagepeople about SIDS being at the highest rate in our area and how we can promoteawareness of ways to prevent it.”Although Bordeaux already knew the importance of putting babies to sleepon their backs, rather than on their stomachs, and of keeping soft beddingand stuffed animals out of the crib until a child turns one year old, other tipsshe learned at the conference came as a surprise.“I didn’t realize there was an association with cigarette smoking and SIDS,”she said. “Everybody talks about how you shouldn’t smoke around kids, butI never realized smoking could be so bad for kids even before they’re born.”So now Bordeaux warns pregnant women on her reservation not to smoke—and not to stand too close to anyone else who is smoking either.“My own daughter is due with her baby in July, and she didn’t even knowthat,” said Bordeaux.When that baby arrives, it’ll be grandchild number three for Bordeaux – butshe sometimes feels as though she’s a grandmother to hundreds of kids. Justrecently, a young woman who once attended Bordeaux’s in-home daycaretelephoned and asked Bordeaux to come with her to the hospital: It was timefor her to deliver her own baby.Bordeaux can’t wait to sing that new little baby girl a lullaby – before she putsthe baby down to sleep on her back, of course.H a v i n g H e a l t h y B a b i e s : T h e S c i e n c e I n s i d e26InfertilityInfertility is the inability to conceivechildren. Doctors think of couplesas infertile if they are not ableto conceive children after a year ofsexual intercourse without birthcontrol.Infertility has many causes.Problems with the male reproductivesystem occur in about 30 percentof infertility cases. Up to 70percent of infertility problems originatein the female reproductive system.Known causes of infertility forboth men and women include emotionalstress, malnutrition, obesity,cancer, abuse of alcohol and drugs,smoking, and certain medical conditions(diabetes, thyroid disease,HIV/AIDS, and others). Femaleinfertility is most often caused bydiseases of the reproductive system,such as pelvic inflammatorydisease and endometriosis.Medications and treatments forinfertility are as varied as the causes.Intense screening and diagnostictests might be necessary to establishthe source of the problem.The woman might be treated withfertility drugs. These are medications,often hormones, whichregulate or bring about ovulation.When a disease such as endometriosishas caused permanentdamage to the reproductive system,in vitro fertilization might beused. In this procedure, the egg27Part 4: Complicationsof pregnancyCommon Pregnancy ComplicationsThe Centers for Disease Control lists the mostcommon complications of pregnancy, whichinclude:• ectopic pregnancy• depression• high blood pressure• infection• complicated delivery• diabetes• premature labor• hemorrhage• miscarriage• excessive vomiting• need for a caesarean deliveryThe CDC also lists the leading causes of maternaldeath:• hemorrhage• blood clots• high blood pressure• infection• strokes• amniotic fluid in the bloodstream• heart muscle disease28H a v i n g H e a l t h y B a b i e s : T h e S c i e n c e I n s i d eand sperm are joined in the laboratoryand then transferred to the uterus.Miscarriage and otherpregnancy lossMiscarriage. A miscarriage is theloss of an unborn child during thefirst 20 weeks of a pregnancy. It oftenoccurs before the mother learns she ispregnant. Between 15 and 20 percentof known pregnancies end in miscarriage.Its medical term is spontaneousabortion.Miscarriage is almost never caused byexercise or sexual intercourse. Inmost miscarriages, the fertilized eggdoes not develop normally. The abnormaldevelopment is due to genetic factors.Miscarriages are also associatedwith risk factors in the mother’shealth, such as smoking, alcohol andillegal drug use, chronic disease, andolder age. A condition called anincompetent cervix is responsiblefor some repeated miscarriages.Women who have already had severalpregnancy losses are at greater riskfor miscarriage in the future.However, miscarriages also take placein low-risk pregnancies. They are usuallynot preventable.Warning signs of a miscarriageinclude vaginal spotting or bleeding,losing fluid or tissues from the vagina,abdominal pain, and cramping. Awoman with those symptoms shouldcall her health care providers andseek help immediately.Ectopic pregnancy. An ectopicpregnancy, also called a tubal pregnancy,is one in which the fertilizedegg develops outside the uterus. Mostof the time (about 95 percent), the eggsettles in the fallopian tube. The eggmight also become implanted in thecervix, abdomen, or ovaries. As anectopic pregnancy goes on, the growingembryo or fetus can burst theorgan that contains it. The rupturecauses internal bleeding and puts themother in danger of her life. Mostectopic pregnancies do not developinto live births.Ectopic pregnancies occur in about 2percent of all pregnancies. Earlydetection of an ectopic pregnancy cansave the mother’s life. The warningsigns include vaginal bleeding, followedby worsening pain in the lowerabdomen. There might also be shoulderpain, dizziness, nausea, andvomiting.Molar pregnancy. A molar pregnancyis one in which the placentagrows abnormally. The baby may notform at all, or be unformed andunable to survive. The rate offrequency is about 1 in 1,000pregnancies.Ultrasound technology (sonograms)can help detect molar pregnanciesearly. Surgery is needed to remove themolar tissue. After the surgery, thewoman is monitored for a year forchoriocarcinoma, a cancer thatcan develop in any remaining molartissue.Warning signs of molar pregnancyinclude vaginal bleeding a weekafter a missed period, abdominalcramping, severe nausea and vomiting,and high blood pressure.Stillbirth. A stillbirth takes placewhen a baby dies in the womb afterthe 20th week of pregnancy. Thishappens in about 1 in 200 pregnancies.Only about 1 in 7 stillbirthstakes place during labor and delivery.Many stillbirths happen withoutwarning in an otherwisehealthy pregnancy. Women withhigh blood pressure and diabetesare at higher risk.A mother’s first notice of a stillbirthis that the baby stops kicking andmoving around. Bleeding from thevagina is another sign. A stillbirthis often diagnosed by ultrasound.Doctors induce labor after the diagnosisin order to save the health ofthe mother. The baby and placentaare examined. However, the causeof death in a stillbirth cannotalways be determined.DiabetesDiabetes is a disease that preventsthe body from digesting sugarsand starches properly. Women whohave diabetes before they arepregnant have more risk factorsfor pregnancy.Type 1 and Type 2 diabetes.Type 1, or insulin-dependent, diabetesis caused by the failure of thepancreas to produce the hormoneinsulin. Young people usuallydevelop this form of diabetes beforeage 20. Patients with Type 1 diabetesrequire daily insulin shots.Type 2, or noninsulin-dependentdiabetes, is brought on by overeatingand poor diet and is associatedwith obesity. This type of diabetescan often be brought under controlwith proper diet, weight loss, andoral medication. Both Type 1 andType 2 diabetes are risk factors forpregnancy. Pregnant women whoare diabetic may need to discontinueor change their medications toavoid harm to the baby.Part 4: Complications of pregnancy29In vitro implantation of embryo into uterus.H a v i n g H e a l t h y B a b i e s : T h e S c i e n c e I n s i d e30Gestational diabetes. Gestationaldiabetes occurs during pregnancyand goes away after the pregnancy isover. Between 3 and 5 percent of pregnantwomen in the United Statesexperience this complication. In gestationaldiabetes, the pregnant woman’ssystem is unable to properly regulatethe release of insulin. As the placentaand fetus grow, more insulin is needed,until the pancreas can no longermake enough insulin to keep up withdemands.There are many risk factors associatedwith gestational diabetes, such asobesity, a family history of diabetes,having too little amniotic fluid, orhaving a history of very large births,stillbirths, or births with birthdefects. Older mothers are also atgreater risk. But many women withoutthose risk factors also developgestational diabetes.Doctors recommend that all pregnantwomen be tested for gestational diabetes.Women who are diagnosed withthis condition will be asked to helpcontrol their blood sugar levels withdiet. The health of the fetus andmother will be monitored to reducecomplications during later pregnancyand childbirth. Health problems dueto gestational diabetes are manageableand preventable.High blood pressureHigh blood pressure (or hypertension)can exist before pregnancy ordevelop during pregnancy (gestationalhypertension). Both types canlead to health problems and complicationsduring pregnancy. Hypertensioncan damage the mother’s kidneysand other organs. A disease associatedwith high blood pressure is preeclampsia.Preeclampsia can lead toan even more serious condition,eclampsia. Problems related to highblood pressure occur in 6 to 8 percentof pregnancies in the United States.Doctors may advise a pregnantwoman with high blood pressure tocontrol her weight, increase exercise,and make other dietary and lifestylechanges. Pregnant women should telltheir doctors about blood pressuremedications they are taking.Preeclampsia is characterized by acombination of high blood pressureand increased protein in the mother’surine. Increased protein in the urinemight be the result of kidney problems.The kidney problems could bethe result of the mother having highblood pressure or diabetes beforepregnancy.Preeclampsia occurs more frequentlyin mothers over 40 and under 20,obese mothers, and mothers withdiabetes, kidney disease, rheumatoidarthritis, lupus, or scleroderma.It is also more commonduring multiple births.Preeclampsia prevents the placentafrom getting enough blood. The placentatherefore cannot nourish thebaby adequately. This can cause lowbirth weight and other problems.Warning signs of preeclampsiainclude severe headaches, excessiveswelling of hands and feet, diminishingurine, blood in the urine,vomiting, double or blurred vision,fever, pain in the abdomen, rapidheartbeat, and dizziness. Specialprenatal care is needed.Fortunately, only a small percentageof women with preeclampsiadevelop eclampsia, a serious conditioncharacterized by seizures.Hospitalization late in pregnancymight also be required if the doctorfeels that eclampsia is a threat.Stress, anxiety,and depressionMental health during pregnancy isanother issue that concerns healthcare professionals. Recent studieshave shown that depression, stress,anxiety, and other mood disordersstrike many mothers, both duringand after pregnancy.Stress can contribute to emotionaland mental problems during pregnancy.Normal worries of parents,such as where to find the extraincome to care for the new baby, canput stress on the mother. The discomfortsof pregnancy can also leadto stress. Research suggests thatstress is harmful because it releasesa hormone that can trigger contractionsof the uterus. Stress also causeshigher blood pressure, elevatedPart 4: Complications of pregnancy31Symptoms of Postpartum DepressionThe U. S. government’s Office on Women’s Health recommends that mothers whoexhibit these symptoms seek professional help:• Restlessness, irritability, or excessive crying• Headaches, chest pains, heart palpitations, numbness, or hyperventilation• Inability to sleep, extreme exhaustion, or both• Loss of appetite and weight loss• Overeating and weight gain• Difficulty concentrating, remembering, or making decisions• Excessive concern or disinterest with the new baby• Feelings of inadequacy, guilt, and worthlessness• Fear of harming the baby or oneself• Loss of interest in sex and other normal activitiesH a v i n g H e a l t h y B a b i e s : T h e S c i e n c e I n s i d e32heart rate, and other negative physicalreactions. Indirectly, stress cancause harm by leading to smoking,drinking, or not eating well.Mood swings and feelings of depressionalso trouble many pregnantwomen. Changes in the body’shormones are the cause of someof these emotional changes. Healthcare professionals can recommenda variety of techniques for reducingstress and improving mental health.Deep breathing, meditation, andother relaxation techniques helpmany women. Support groups andchildcare classes relieve anxietiesabout pregnancy.Postpartum depression amongmothers who have just given birthranges from mild to severe. About 10percent of pregnancies result in postpartumdepression. An even moreserious mental illness, postpartumpsychosis, may affect as many as1 in 1,000 new mothers. Women whosuffer postpartum depression exhibita wide variety of physical symptoms.Studies have linked these symptomsto hormonal changes and to drops inthyroid levels. There are significantlinks between postpartum depressionand pre-existing mental disorders, aswell as to extreme stress and abuseat home. Although the exact causesof postpartum depression are not yetknown, health care professionals doknow about medications and othertreatments that alleviate the condition.Pregnant women and newmothers are urged to seek professionalhelp and to discuss their feelingsopenly with their nurses and doctors.Postpartum depression, like all formsof depression, is treated with combinationsof counseling and drugtherapy.Premature laborand childbirthThe best chance for a healthy baby isa full-term pregnancy. The baby needsthose last weeks in the womb todevelop its lungs for breathing ontheir own. Important brain growthalso occurs during the last weeks ofpregnancy. A full-term delivery happensabout 40 weeks after the mother’slast menstrual period. Ten toeleven percent of babies are born premature—they are delivered 3or more weeks before the due date.Premature labor. Prematurelabor can take place at any time duringthe last four months of pregnancy.Early labor poses some health risks tothe mother. But doctors sometimesinduce early labor in mothers, inPart 4: Complications of pregnancy33cases where the health dangers aregreater if the pregnancy continues.In general, the later in the pregnancythe mother gives birth, the betterher baby’s chances will be forhealthy survival.Not all premature labor ends inimmediate delivery. In many cases,doctors are able to stop prematurecontractions. Extra fluids, bed rest,and medications such as musclerelaxants are used to stop contractions.Extra care, even hospitalization,may be required for the rest ofthe pregnancy. If premature laborcannot be stopped, doctors givemothers medications that preparethe baby for birth. They might alsogive mothers medications that stoplabor briefly, to make a safer prematuredelivery possible.Premature delivery. Risks to themother during premature deliveryare higher than for full-term births.The higher risks are partly due todifferences in procedure. For example,premature births are oftenmedical emergencies. Early birthsmore often involve c-sections andother extra procedures. Medicationsthat stop contractions can alsocause fluid to build up in the lungs,which can complicate delivery.In spite of the higher risk, however,most premature deliveries are physicallysafe for the mother.Babies are at much higher riskthan mothers during and afterpremature delivery. Prematurebabies usually need perinatalcare to survive.Very premature babies will requiremonths in intensive care in thehospital. Mothers who give birthprematurely are at high risk forpostpartum depression and mayneed medication, counseling, orboth.Premature Labor: Signs and CausesPregnant women should stay alert for these warning signsof premature labor:• vaginal spotting or bleeding• abdominal cramps like menstrual cramps• low back pain• feeling pressure on the pelvisA woman should seek medical help as soon as she experiencesany of the above warning signs.Medical emergencies that require a doctor immediately are:• regular contractions of the uterus• watery discharge from the vaginaOnly about half of the cases of premature labor can beexplained. Known causes of premature labor include:• a rupture in the amniotic sac• infections and disorders of the uterus, cervix, or urinarytract• certain chronic diseases, including high blood pressure,kidney disease, diabetes, and hyperthyroidism• previous premature deliveries• smoking, alcohol, and drug use by the mother• malnutrition in the mother• congenital defects in the babyH a v i n g H e a l t h y B a b i e s : T h e S c i e n c e I n s i d e34Neonatalintensive carePerinatal care isthe medical care ofpremature infantswho cannot surviveon their own. Suchcare takes place in thehospital, in neonatalintensive care units(NICUs). (Neonatalmeans newborn.)NICUs also care forfull-term babies whodevelop problemsafter birth.Most babies in NICUs are kept inincubators. The incubator serves asan artificial womb for the prematurechild. It keeps the baby warm andfree of infections. Depending on itsage, the baby will receive intravenousfeeding, be fed througha tube in the nose, or be fed witha bottle. The baby’s blood pressure,heart rate, breathing, and temperatureare carefully monitored.Infants stay in NICUs until they nolonger need continuous hospital care.To go home, a baby must have a stabletemperature, be able to nurse,and be gaining weight. Such infantswill need special care at home. Theyoften cannot breastfeed. Infants bornprematurely need closer monitoring,more frequent doctor’s visits, andmore medications than full-terminfants.NICUs are increasingly successful inkeeping even very premature babiesalive. However, very young prematurebabies (between 23 and 25 weeks old)have higher death rates and higherrisks of serious medical problems.Only 30 to 50 percent of babies bornat 23 weeks survive. Babies 25 weeksold have a 60 to 90 percent survivalrate.Very young premature babies whosurvive are at high risk. About twothirdsof premature babies who weighless than 2 pounds at birth havedevelopmental problems. Half of those(one-third of the total) are seriousmedical problems, such as cerebralpalsy, seizures, and hydrocephalus(too much fluid in the brain). Theremay also be lasting nerve damage.The other half (one-third of the total)are less serious chronic health problems,including slower growth rates,increased incidence of infections,vision and hearing problems, andslower rates of learning.Older premature babies have higherchances of surviving and growing uphealthy. However, all prematurebabies are at high risk for low birthweight. Babies who weigh less than5 pounds, 8 ounces are at higher riskfor medical complications than babieswho are born at normal weight(7–8 pounds).Knowingthe riskfactors canhelp predictand preventcomplicationsof pregnancyand childbirth.35Part 4: Complications of pregnancyThe Root Cause ofBetter LearningBarbara Bowman knew she’d found herlife’s calling when she walked into a nurseryschool and looked into the bright eyesof young children.At the time, Bowman was a college student,and visiting the nursery school was arequirement for a school course. ButBowman discovered that even after she’dcompleted the class, she didn’t want to saygood-bye to the kids.“I was fascinated with how interestingyoung children were, even babies,” she says. “I was pretty good at talkingto them, responding to them. They liked me and I liked them.”Now Bowman stands as one of the nation’s foremost experts in earlychildhood education. During her 50-year career, she has served on WhiteHouse panels, national science advisory boards – and she even has a streetnamed after her in her hometown, Chicago. But ask her about her mostimportant achievement, and you can hear the pride in her voice shinethrough as she talks about her own daughter and 17-year-old granddaughter.As a parent and an educator, Bowman knows every mother and fathercan take simple steps to set the stage for a lifetime of better learning fortheir children. Just because babies don’t yet talk doesn’t mean they’re notcapable of learning. In fact, research shows the most rapid and significantgrowth of a person’s brain occurs during the first year of life.Parents don’t need flashcards or special kinds of music to stimulate theirbabies’ brains. In fact, the most important thing they can do is spend timeplaying with and talking to their children, Bowman says.“We know when infants are stimulated pleasantly – not too much, nottoo little – it does make them smarter,” Bowman says. “Letting babiesBETTER LEARNING, continued on next page36H a v i n g H e a l t h y B a b i e s : T h e S c i e n c e I n s i d ehandle things, playing with them, and giving them body rubs are examplesof things that children get pleasure from that are good for them and helpmake them smart.”Bowman says that while reading to children is important, parents who areunable to read well themselves might shy away from books. There’s a simplesolution, she says: Take your children to story time at the local library andencourage them to retell stories they have heard.Bowman has seen firsthand how the challenges of preparing children tolearn are felt around the world. After she married, she traveled with her husbandto Iran and worked with children in orphanages and public schools andspent time with tribes. After returning to Chicago, she helped form theErikson Institute, which trains daycare directors, teachers of young children,and other child-centered professionals to enter the workforce.Bowman knows that just as strong, healthy roots allow a tree to stretchtoward the sky, giving young children the things they need early on letsthem soar to their full potential. And to a child, love is just as important asfood to eat and air to breathe.“The early experience of being well taken care of and having somebodyenjoy being with you and all those very simple things are what builds achild’s capacity to love,” Bowman says.With those kinds of roots, the sky can be the limit for any child.37Part 5: Health care ofinfants and toddlersCaring for an infantat homeFeeding the new baby. Breastmilk or infant formula is the mainsource of nutrition for a baby in itsfirst year of life. The advantages ofbreastfeeding infants are wellestablished. Breast milk from ahealthy mother strengthens thebaby’s immune system, provides thebaby with complete nutrition, and iseasier than formula for the infant todigest.The alternative to breast milk is aninfant formula. The mothershould consult health care professionalsin choosing the best typeand brand for the baby’s specificneeds. Infant formulas must be preparedand stored safely to protectthe baby’s health.Babies can start eating solid foodwhen they are 4 to 6 months old.Solid food should be introduced littleby little. The baby’s specific dietshould be planned with the help ofhealth care professionals. Doctorsmight recommend vitamin supplementsor dietary changes for underweightor overweight infants.Baby’s MilkFor most babies, the healthiest food is their mother’s milk.Here are some of the advantages of breast milk from a healthymother:• Strengthens the infant’s immune system• Provides complete nutrition for the infant• Is easier for the infant to digest• Helps low birth weight babies gain weight faster• Costs much less than infant formulaInfant formula is also healthy for infants when it is preparedand stored correctly. Here are some rules for safe bottlefeeding.• Sterilize all bottles and nipples before use.• Formula should be mixed only with water that has beenboiled. Boil the water for at least two minutes. After thewater has cooled to warm, mix with the formula.• Mix the formula in the correct proportions.• Keep prepared formula in the refrigerator. Use within 48hours.• Warm the refrigerated formula before feeding the baby.Whole milk is not good for infants. It should not be part of ababy’s diet until sometime around the first birthday.H a v i n g H e a l t h y B a b i e s : T h e S c i e n c e I n s i d e38Keeping clean. Newborn babiesshould get warm sponge baths untilthe umbilical cord falls off and thebaby is otherwise recovered fromchildbirth. Cleanup after each diaperuse and daily sponge baths remainthe safest forms of bathing until thebaby can hold its head up on its own.Bathing a newborn in a sink or tubshould be done only with extremecare, preferably by two adults.The baby’s entire environment shouldbe kept as clean as possible. Peoplewho handle the baby should observegood hygiene habits, especiallywashing the handsthoroughly after using thebathroom and after changingthe baby’s diapers.The baby’s toys should besterilized or washed frequently.Keeping safe. Parentshave the responsibility toprovide a safe home environment.This is more of achallenge as the babybecomes more able tomove on its own. A houseshould be “baby-proofed”to eliminate accident risks, such asopen electrical plugs and householdchemicals (most cleaning products).Playpens and other safe areas canalso reduce danger. Consumerguidelines should be followed in buyingcar seats, cribs, playpens, walkers,and other baby furniture andtoys.Postnatal medical careRegular visits to doctors and clinicshelp keep babies healthy. It is commonfor the baby to have two doctor’sappointments in the first month oflife and one visit a month for the firstyear. High-risk infants may requiremore frequent visits.During visits, health care professionalsmonitor the baby’s growth anddiscuss any concerns the parentsmay have about the baby’s health.They can help the parents learn torecognize common childhood ailmentsand how to treat them. Doctors alsorecommend that infants and toddlersbe immunized against common childhooddiseases.Risks to infant healthA healthy baby is born with a strongimmune system, which gets evenstronger if the baby is breastfed by ahealthy mother. With good nutritionand a healthy, caring environment,most infants stay healthy and growup normally. There are, however,some medical conditions that threateninfants, especially infants who arealready at risk.Sudden infant death syndrome(SIDS). Sudden infant deathsyndrome (SIDS) is the sudden andunexplained death of a baby underone year of age. The cause is notknown. However, certain risk factorsare known. SIDS occurs more oftenwhen mothers smoke during or afterBabies use all theirsenses to explorethe world, so it isimportant to babyproofa house toprevent them fromputting dangerousthings in theirmouths.39Part 5: Health care of infants and toddlerspregnancy, or if the baby is bornprematurely or with low birthweight.Doctors have an important newmessage to spread: babies who sleepon their backs have a significantlylower rate of SIDS than babies whosleep on their stomachs. Putting thebaby to sleep on its back dramaticallyreduces the risk of SIDS.Failure to thrive. Failure tothrive is the term used when ababy is consistently behind normalgrowth for its age group. Premature,low birth weight, and undernourishedbabies are most likely tosuffer from it. Failure to thrive canresult from many different causes.The warning signs include beingunderweight and having low levelsof response, a high rate of infectionsand childhood illnesses, and learningdisabilities.Shaken baby syndrome. Shakenbaby syndrome is a severe headinjury that occurs when a baby isshaken hard enough to cause thebaby’s brain to bounce against hisor her skull. Sometimes, parents orother caregivers may shake a babyout of frustration, thinking that it isharmless. Shaking a baby, however,can be just a dangerous as hittingor other forms of abuse. The bouncingof the brain against the skullmay cause bruising, swelling, andbleeding of the brain, which maylead to permanent, severe braindamage or death.The warning signs of shaken babysyndrome may include changes inbehavior, irritability, tiredness, lossof consciousness, pale or bluishskin, vomiting, and seizures.It is important for parents to be onthe alert for any signs of illness orunusual behavior in infants andbabies. Even small concerns shouldbe brought to a doctor’s attentionduring regular medical checkups.Health in infancy and earlychildhoodBabies who are one to three monthsold become ever more interactive.They discover their parents andother familiar faces. They learn tosmile and make noises in responseto other people. They learn to reachfor and grasp objects. They playwith their toes.New babies continue to kick,stretch, and develop stronger bonesand muscles during their fourththrough seventh months. Graduallythe baby learns to hold up its head,roll over, squirm along, and start tocrawl. He or she responds more andmore to toys, starts to imitate adultmovements—and keeps workingtoward crawling and walking.Babies make a huge amount ofprogress in their intelligence, mobility,language skills, and interactionswith others as they approach theirfirst birthdays. Between theirReducing theRisk of SIDSThe NationalInstitute of ChildHealth and HumanDevelopment recommendsthe followingto help lower therisk of sudden infantdeath syndrome:• Place the baby onhis or her back tosleep.• Place the baby ona firm mattress.• Remove all pillows,fluffy blankets,and stuffed toysfrom the crib.• Keep the baby’shead and faceuncovered duringsleep.• Do not smokebefore or after thebirth of the baby.• Keep the babyfrom overheatingduring sleep.eighth and twelfth months, babieslearn to crawl. They love doing it andget better and better at it. They alsolearn to pull themselves up.Most babies start to walk by theirfirst birthday and improve their walkingin the months that follow. As thechild masters walking, he or she mayalso be learning to climb stairs or tobend over and stand up again withoutfalling.A baby’s skills (what the baby can do)develop quickly in early childhood.Health care and early childhoodexperts use skills to mark theprogress of children’s mental andH a v i n g H e a l t h y B a b i e s : T h e S c i e n c e I n s i d e40The American Medical Association liststhese signs as warnings that a baby is notdeveloping normal skills:1 to 3 months• Cannot support its own head• Cannot hold its head up 45 degrees• Cannot grasp or hold objects• Cannot make fist• Does not press down legs when feet areon a flat surface4 to 7 months• Has stiff or tight muscles• Feels extremely floppy• Does not use one side of the body• Favors one arm or leg• Cannot get objects to his or her mouth• Cannot roll over by 5 months• Cannot sit when supported by 6 months• Cannot control head adequately at 7months• Does not reach for objects by end of 7months8 to 12 months• Cannot crawl• Cannot stand when supported• Does not use both sides of the bodyequally• Cannot control hands• Says no simple words (“mama,” “dada”)• Does not use gestures, such as wavingor shaking head• Does not point to objects or picturesBy the end of 3 years• Falls frequently• Has difficulty with stairs• Drools persistently• Has very unclear speech• Cannot build a tower of more thanfour blocks• Has difficulty manipulating smallobjects• Cannot copy a circular shape• Cannot communicate in short phrases• Does not get involved in “pretend” play• Fails to understand simple instructions• Shows little interest in other children• Has extreme difficulty in separatingfrom motherSource: Adapted from American Medical Association,Caring for Baby and Young Child, Bantam, 1999.Online at www.medem.com.Warning Signs in Infancy and Early ChildhoodPart 5: Health care of infants and toddlers41physical health. Such guidelinesfrom the experts are very useful inunderstanding the general progressof a healthy baby’s growth.However, the guidelines shouldnever be read as absolute. Healthcare professionals know thathealthy babies develop at differentrates. They can help mothers,fathers, and other caregivers givethe baby the best possible environmentfor healthy growth.Smart babies: Learningthrough playNew research shows that a baby’sbrain starts developing much earlierthan experts used to think. Parentstoday are encouraged to start teachingtheir infants soon after birth bystimulating the baby’s senses andthrough guided play. Early teachingcan help high-risk childrenavoid learning disabilities and helpbabies interact better with others ata much younger age.Health care professionalscan now teach parentssimple physical exercisesthat encourage the baby’smuscle and bone growth.Parents can learn how touse tones of voice, gestures,shapes and colors,and toys to focus thebaby’s attention and helpits growing brain makeconnections. The excitingfield of early childhoodlearning is proving thatone of the healthiestthings parents can do isto play with their baby.Helping a baby learn brings rich rewards.H a v i n g H e a l t h y B a b i e s : T h e S c i e n c e I n s i d e42Laboring toDeliver PerfectMiraclesWhen she was a little girl, StaceyGarnett loved to carry around heraunt’s black nurses’ bag and cure theimaginary fevers and scrapes of herbaby dolls. All that practice came inhandy; today, many of Garnett’spatients are the same size as thosedolls from long ago.Garnett is indeed the nurse shedreamed of becoming, and her jobis more rewarding than she ever imagined. As the director of maternal-childhealth nursing at Mercy Medical Center in Baltimore, Maryland, she gets towitness daily miracles as she oversees the hospital’s labor-delivery unit.“The care of a laboring woman is so exciting,” says Garnett. “Helping themthrough the delivery of a baby, when everyone in the room is crying or lookingon in amazement or yelling, is one of the best parts of my job.”But Garnett knows not every pregnancy has a picture-perfect ending. Shealso manages the neonatal intensive unit, where sick and premature babiesare treated. Although science has made great strides in treating babies borntoo early, she notes, women still need to do everything they can to carry theirbabies a full nine months.One of the most important steps women should take is also one of the easiest:Take prenatal vitamins. “Women should start taking prenatal vitamins ifthey even think they’re going to conceive,” she stresses.Seeing a doctor regularly is critical, since pregnancy can sometimes beaccompanied by diabetes or other life-threatening conditions.“Doctors take blood and look at different things, like whether a woman isanemic,” Garnett says. “They can also test to see if a woman is HIV-positive.If she is, she and the baby can receive treatment. Doctors will also take ultrasoundsto make sure the baby is growing properly and is in the uterus.”CLB: Strip in photoprovided. Adjustphoto box as necessary.Garnett feels a special concern for women who live in the inner city, sincemany of them are poor and it can be hard without a car to get to a doctor.But it’s those very women who can gain the most from medical care, sheadds. By contacting a local social service office, pregnant women often cansee doctors through the Medicaid program – and learn about other programsthat can help them pay for things like groceries and infant formula.“Many women don’t realize the resources available to them, and in mostcases, because you’re pregnant, they’re free,” says Garnett.But Garnett is trying to spread the word. Recently, she began to travel toarea high schools to talk to students about her job. Her goal is twofold:She wants to stress the importance of good health care to students whomay become pregnant – and she wants to encourage students to considerentering the field of nursing.After all, there aren’t many jobs that pay you to witness miracles.Part 3: How is type 2 diabetes diagnosed and treated?43

Identifying risk factorsand risk disparitiesMuch of today’s research on pregnancyand childbirth involvescounting and calculating the numberof times certain risk factorsappear in certain kinds of women.Research on risks can help pinpointboth medical and social causes forhealth problems.For example, researchers examinedthe hospital records of 38,402 blackwomen and 144,285 white womenwho had given birth in a hospital,looking for risk factors for eclampsia.The study found that youngerwomen (ages 15 to 19) had a higherrisk of eclampsia than older women(ages 20 to 39). There was a higherincidence of eclampsia amongwomen with diabetes and urinarytract infections. The most impressivefindings showed that, regardlessof race, women with chronichypertension had an 11 timesgreater risk of suffering eclampsiaduring pregnancy.In general, data on risk factors aremore reliable if more cases arecounted. In one study, researchersstudied birth records for more than11 million live births between 1995and 1997. The study found thatwomen who had maternal feverduring labor had a three times45Part 6: New researchabout mothers andbabiesThese figures come from the SafeMotherhood Initiative of the NationalCenter for Chronic Disease Preventionand Health Promotion:• In the United States, 2 or 3 womenevery day die from complications ofpregnancy.• African-American woman are 4 timesas likely as white women to die fromcomplications of pregnancy. AmericanIndians are nearly twice as likely to dieas whites.• Deaths of women from pregnancydeclined sharply between 1900 and1982. But there has been no significantprogress since 1982.• Up to 300,000 pregnant women in theUnited States each year are victims ofviolence from their intimate partners.Grim Statistics on Pregnancy and Childbirthgreater risk ofearly neonataldeath (deathamong prematurelyborn babies) andtwice the riskof death of theirfull-term infants.The data alsoshowed that maternalfever was associatedwith respiratory disorders inboth premature and full-term newborninfants.As researchers examine hospital andMedicaid records and other data, theyoften note critical risk disparitieswithin the population of the UnitedStates. For example, research showsAfrican-American women to be athigher risk for complications duringpregnancy, premature births, and lowbirth weight babies than whitewomen. If a particular ethnic grouphas a higher incidence of a medicalcondition, researchers look for clues inthe diets and lifestyles of that groupas well as in that group’s geneticprofile. In trying to explain the disparity,researchers also look at suchcontributing factors as access to medicalcare.Science has made clear cause-andeffectconnections between many riskfactors and pregnancy complications.For example, lack of folic acid in thediet has been shown to cause spinabifida and other birth defects. Thisresearch has led to dramatic, veryquick progress in reducing spinalrelatedbirth defects—simply by educatingwomen of childbearing age toadd folic acid to their diets.Discovering causes forpregnancy complicationsScientists are making impressiveadvances in discovering the actualmechanisms by which risk factorswork. For example, researchers foundthat women with high levels of stressin the midpoint of their pregnancies(weeks 18 to 20) were more likely tohave high levels of CRH (corticotropin-releasing hormone) intheir blood. High levels of CRH havebeen linked to preterm labor. The hormonesignals the uterus to begin contracting,which helps bring on labor.The race to understand and cureHIV/AIDS and other modern diseaseshas led to many recent advances inimmunology. Now science is startingto connect disorders of the immunesystem to miscarriage and otherforms of pregnancy loss. Scientistsestimate that up to 40 percent ofunexplained infertility and up to 80percent of unexplained pregnancy lossmight be due to immune system problems.Researchers have identifiedat least four autoimmune problemsthat can cause frequent miscarriages.These findings encourage couples totest their immune systems beforepregnancy or in its early stages. Testsof the immune system (such as testsfor HIV/AIDS) become even moreH a v i n g H e a l t h y B a b i e s : T h e S c i e n c e I n s i d e46important if a mother also hasother risk factors for pregnancy(such as being under 20 years old orhaving a sexually transmitted disease).The findings have also encourageddoctors to prevent pregnancy lossby treating the autoimmune systems.For example, a doctor mightprescribe aspirin or heparin toreduce the risk of inflammation andclotting, or prednisone, a steroidused to treat inflammation. Continuingclinical trials of these andother treatments will establishtheir safety and the most effectiveway to use them.New discoveries in genetics are alsohelping scientists understand themechanisms of pregnancy. Forexample, a study conducted in 1997found that as many as 1 out of 7people carried a genetic trait thatcauses a deficiency in folic acid.People carrying this trait have troublebreaking down the vitamin intheir blood. A different studyshowed that pregnant women withthis genetic trait might have anincreased risk of problems with theplacenta. Because of these researchresults, the scientists recommendedthat women with this genetictrait take more folic acid duringpregnancy.Evaluating prenataland postnatal careSome research on pregnancy andchildbirth focuses on the medicalcare that women and babies receive.The goals of such research are oftensocial as well as medical. Researchersmight try to find the bestmethods of reaching women withimportant health information orfind better ways to give morewomen access to prenatal and postnatalcare. Some research focuseson how doctors and hospitalsmanage medical care.A good example is the research oncaesarean sections (c-sections). Therate of c-sections performed in theUnited States rose rapidly duringthe 1950s, 1960s, and 1970s. It leveledoff in the 1980s and thenbegan to go down. However, manyauthorities say that the rate is stilltoo high: In 1995, 20.8 percent—about 1 in 5—deliveries took placeby c-section.Researchers at theUniversity of Syracuseare currently trying toidentify the factors thatcause these high rates.Earlier research has suggestedthat the causesmay be financial as wellas medical. For example,researchers studied allthe hospitals in one coun-Part 6: New research about mothers and babies47Taking partin researchprojectshelps othermothers andbabies behealthy.ty in California during 1991. Theyfound that 24.9 percent of theMedicaid-insured women who gavebirth in private hospitals hadc-sections. In public hospitals, only9 percent of Medicaid-insured womenwere given c-sections. In a differentstudy, researchers studied 733 womenwho delivered full-term infants byunplanned c-section. The studyfound that nearly one-fourth of thec-sections performed because laborwas not progressing fast enoughwere performed too early in labor.Researchers also evaluate the roleof education, health insurance, andother factors in reducing pregnancyrisks. The results of such studiesshow that the causes of risk disparitiesare quite complex. Researchersat the University of Alabamaarranged for about 300 Medicaideligiblepregnant African-Americanwomen to receive the usual prenatalcare. About the same number of suchwomen were given extra education,more clinical attention, and riskreductionprograms. The resultsshowed many positive effects, suchas an increased sense of control onthe part of the women and greatersatisfaction with the health care.However, the women who receivedthe extra help did not have a lowerrate of low birth weight babies.For low-income women, the lack ofhealth insurance is a major cause ofnot seeking adequate prenatal care.A California study of more than 3,000low-income women also identifiedother barriers to adequate prenatalcare: unwanted or unplanned pregnancy,lack of a regular healthcareprovider, and having less than a highschool education.The vital role of volunteersAdvances in care for women and theirbabies depend upon research volunteers.These are women who agree toshare information about their healthto survey takers, donate tissue samplesfor lab study, and participate inclinical trials.Research shows huge risk disparitiesbetween mothers from differentracial, ethnic, and income backgrounds.Women’s health researchneeds research volunteers from allracial and ethnic groups, of bothgenders, and of all ages and lifestyles.Women who enroll themselves andtheir babies in clinical trials stand abetter chance of receiving potentiallyeffective treatments earlier than others.At the very least, medical personnelwill monitor their health duringthe course of the trial, and they willhave the best standard of care. Thesevolunteers also get the satisfaction ofhelping to uncover information thatcould someday improve health formothers, babies, families, andcommunities.H a v i n g H e a l t h y B a b i e s : T h e S c i e n c e I n s i d e48Pregnancy, childbirth, and infantcare do not have to mean so muchrisk to so many mothers andbabies. Many of the worst problemscan be avoided by changes inlifestyle and following simple procedures.Here are some steps you cantake:Educate yourself and othersabout pregnancy and childbirth.You have begun to do so byreading this book. Keep up thiseducation process. Check the booksand periodicals in your library. Usea computer to search the Internet.Librarians will help you in yourInternet search. As you read, writedown questions. Then search forthe key words in your questions tofind more information. TheResources section of this book listsplaces to start your search.Recognize that you can make adifference in your own healthand the health of your baby.It is critical that you get both prenataland postnatal care. But justas important are the health measures—healthy lifestyles, good nutrition,clean environments—thatmothers practice at home.Identify risk factors and preparefor them. If any of the riskfactors for pregnancy (see pages3-7) apply to you,bring them to theattention of yourdoctor. Read moreabout the riskfactors and makerecommendedchanges in yourlifestyle and diet.Help bring wellmotherand wellbabyprogramsinto your community.Learnfrom the programsthat have succeededin communitieslike yours. Do volunteerwork with local organizationsthat run clinics for women,education programs, and similarefforts. (To obtain a small grant tosupport your community preventionprogram, see Healthy People 2010in the Resources list on page 52.)Volunteer for research trials.Obtain information on upcomingtrials. Volunteer yourself for a trial,and promote these opportunities toother women. Find out if your communitycan be a site for a researchtrial on health issues related topregnancy, childbirth, and childcare.49Conclusion: Making mothersand babies healthier

51ResourcesAgency for Healthcare Research and QualityDepartment of Health and Human Serviceswww.ahrq.govAmerican Academy of Pediatrics141 Northwest Point BoulevardElk Grove Village, IL 60007-1098847-434-4000847-434-8000 (fax)www.aap.org, www.kidshealth.org, www.medem.comAmerican Diabetes AssociationPromotes diabetes prevention and treatment and advocates for improvedquality of life for people with diabetes.National Service Center1701 North Beauregard StreetAlexandria, VA 22311800-DIABETES or 703-549-1500www.diabetes.orgBody Mass Index Information for Adults and ChildrenProvides automatic calculators of body mass index (useful for determiningrisk of diabetes and other conditions based on overweight and obesity).Found at the website of the Centers for Disease Control.www.cdc.gov/nccdphp/dnpa/bmi/ClinicalTrials.govA web-based resource for finding clinical trials in need of volunteers.www.clinicaltrials.govSelect the “pregnancy” topic to search for pregnancy-related trials.Comprehensive Health Information DatabaseA web-based service that combines resources on maternal and child healthand other health topics from several federal agencies. A service of theNational Institutes of Health.www.chid.nih.gov/simple/simple.html52H a v i n g H e a l t h y B a b i e s : T h e S c i e n c e I n s i d eErikson InstituteGraduate school and research institute that specializes in early learning.420 North Wabash AvenueChicago, IL 60611-5627312-755-2250www.erikson.eduHealthy People 2010A nationwide health promotion and disease prevention campaign sponsored bythe Department of Health and Human Services. One of the goals of the campaignis to reduce health disparities.Office of Disease Prevention and Health Promotion200 Independence Avenue SW., Room 738GWashington, DC 20201www.healthypeople.govFor information on the “Healthy People 2010 Microgrant” program that financescommunity-based prevention activities:www.healthypeople.gov/implementation/community/Indian Health Service National Diabetes ProgramSupports and promotes health efforts that prevent and control diabetes amongNative Americans.Indian Health Service5300 Homestead Road, NEAlbuquerque, NM 87110505-248-4182March of Dimes FoundationThe foundation maintains a massive online library of detailed informationabout pregnancy, pregnancy disorders, infant and maternal health, and birthdefects and their prevention.www.modimes.orgMedem.comA comprehensive service of online health information, provided by members ofseveral medical societies.www.medem.comMedlineplusA comprehensive source of health information, provided by the National Libraryof Medicine.www.nlm.nih.gov/medlineplus53National Black Child Development Institute1023 15th Street N.W., Suite 600Washington, D.C. 20005202-387-1281202-234-1738 (fax)www.nbcdi.orgNational Center for Chronic Disease Prevention and HealthPromotionPromotes the transfer of research knowledge into actual prevention andtreatment strategies. Provides information to the general public.Centers for Disease Control and PreventionDivision of Diabetes TranslationMail Stop K-104770 Buford Highway, NEAtlanta, GA 30341-3717800-CDC-DIABwww.cdc.gov/diabetes/National Center on Minority Health and Health DisparitiesPromotes the health of racial and ethnic populations through research andeducation and through support of minority involvement in research careers.Affiliated with the National Institutes of Health.6707 Democracy Blvd., Suite 800MSC 5465Bethesda, MD 20892-5465800-444-6472 or 301-402-1366www.ncmhd.nih.govNational Institutes of HealthThe biomedical arm of the federal government, which funds research andpromotes education on pregnancy and hundreds of related issues.Website for general information about NIH publications:www.nichd.nih.govSee also Medlineplus for health information available to the public online.National Women’s Health Information CenterNWHIC is a service of the Office on Women’s Health in the United States.Department of Health and Human Services.1-800-994-WOMANwww.4women.govResourcesH a v i n g H e a l t h y B a b i e s : T h e S c i e n c e I n s i d e54Native American Research Centers for HealthResearch centers that link the Native American community with health researchand that work to increase the number of Native American scientists and healthprofessionals.National Institute of General Medical SciencesNational Institutes of Health45 Center Drive MSC 6200Bethesda, Maryland 20892-6200301-496-7301www.nigms.nih.gov, www.nigms.nih.gov/news/releases/narch.htmlNew York Online Access to HealthA searchable health information resource in English and Spanish.www.noah-health.org/index.htmlOffice for Protection from Research RisksA source of information on the guidelines and ethics of research studies withhumans.National Institutes of HealthOffice for Protection from Research Risks6100 Executive Blvd., Rm. 3D01Rockville, MD 20892-7507Office of Minority Health Resource CenterServes as a national resource and referral service on minority health issues,including pregnancy. Affiliated with the U.S. Department of Health and HumanServices.P.O. Box 37337Washington, D.C. 20013-73371-800-444-6472www.omhrc.gov/omhrc/55Appendix 1: Questions to AskYour Doctor about Pregnancyand ChildbirthIf you want to get pregnant or think you might be pregnant...• Am I at risk during pregnancy?• Should I be tested for genetic traits?• How should I change my lifestyle diet to prepare for pregnancy?• What help is available for making those changes?If you have been diagnosed as pregnant...• What tests do I need right away?• How often should I see the doctor?• What is the treatment plan?• What lifestyle changes are required by this treatment plan?• What other specialists do I need to see?• What medications should I be taking or not taking?• With my medical history, what risks should especially concern me?• What can I do to make pregnancy and childbirth easier?• What are the emergency signs I should look out for?• Can you help me locate a clinical trial to join?• Are the conditions I am experiencing something to worry about?• Why am I feeling this discomfort?When you are caring for infants...• What are the risks to my infant because of my experiences inpregnancy?• How often should the baby see the doctor?• What immunizations should my baby receive, and when?• Am I giving my baby proper nutrition?• Why is my baby not acting like other babies the same age?• What medications should my baby be taking or not taking?• What are the emergency signs I should look out for?• Can you help me locate a clinical trial to join?56H a v i n g H e a l t h y B a b i e s : T h e S c i e n c e I n s i d eA research study is a way for finding answers to difficult scientific or healthquestions. Here are important questions you should ask of anyone whowants you or members of your family or community to be part of a researchstudy on pregnancy, childbirth, or infant health.1. What is the study about?• Why are you doing this study?• Why do you want to study me or people like me? Who else is beingstudied?• What do you want to get out of this study?• What will you do with the results?• Have you or others done this type of study ever before? Around here?What did you learn?2. Who put this study together?• Who is running or in charge of this study?• Whose idea was this study?• How were people like me part of putting it together?• Who are the researchers? Are they doctors or scientists? Who do theywork for?• Have they done studies like this before?• Is the government part of this study? Who else is a part of this study?• Who is paying for this study?• Who will make money from the results of this study?3. How can people like me share their ideas as you do this study?• How will the study be explained in my community?• Who of people like me will look at this study before it starts?• Who of people like me are you talking to as you do this study?A Community Advisory Board?• Who from the study can I go to with ideas, questions, or complaints?• How will people like me find out about how the study is going?4. Who is going to be in this study?• What kinds of people are you looking for? Why?• Are you trying to get minorities in this study?• Are you including people less than 18 years old?• How are you finding people for this study?• Are transportation and/or daycare provided for people in this study?• Do I need to sign to participate?Appendix 2: Taking Part inResearch Studies–Questions to Ask57Appendix• Will you answer all of my questions before I sign the consent form?• Can I quit the study after signing the consent form? If I quit the study,will anything happen to me?5. What will I get out of this study?• What are the benefits?• Is payment involved? How will I be paid?• Will I get free health care or other services if I participate? For how long?• Will I get general health care and/or psychological care if I participate?For how long?6. How will I be protected from harm?• Do I stand a chance of being harmed in this study? In the future?• Does the study protect me from all types of harm?• If I get harmed, who will take care of me? Who is responsible?• If I get harmed in any way, will I get all needed treatment?Who pays for treatment?7. How will my privacy be protected?• Who is going to see the information I give?• Will my name be used with the information?• What happens to the information I gave if I quit the study?• Is there a written guarantee of privacy?8. What do I have to do in this study?• When did you start this study? How long will it last?• How much of this study have you already done?• Have there been any problems so far?• Will I get treated the same as everyone else?• What kinds of different treatments are offered in this study? Are thereboth a real and a fake treatment?9. What will be left behind after the study is over?• What will happen to the information people give? How will it be kept?• What are you going to do with the results of the study?• How will the public learn about the results? Will results be in placeswhere the public can see them?• Are you going to send me a copy of the results? When?• What other studies are you planning to do here?The questions above are from a pamphlet developed by Project LinCS (Linking Communitiesand Scientists), Community Advisory Board (Durham, NC), and Investigators (University ofNorth Carolina Center for Health Promotion and Disease Prevention) in cooperation with theCenters for Disease Control and Prevention, Atlanta, GA, email: hivmail@cdc.gov. For copiesof this brochure: CDC National Prevention Information Network 1-800-458-523158Appendix 3: RecommendedChildhood and AdolescentImmunization ScheduleRECOMMENDED CHILDHOOD AND ADOLESCENT IMMUNIZATION SCHEDULE •UNITED STATES • 2003H a v i n g H e a l t h y B a b i e s : T h e S c i e n c e I n s i d eAppendix59FOOTNOTESRECOMMENDED CHILDHOOD AND ADOLESCENT IMMUNIZATION SCHEDULE • UNITED STATES • 2003